Dr. Stanford Addresses Barriers and Disparities in Obesity Treatment

April is National Minority Health Month—a time to raise awareness on issues impacting health disparities and health equity in America. Learn how Mass General’s Dr. Fatima Cody Stanford is addressing barriers and disparities by taking a holistic approach to both treat and advocate for patients who have obesity.

As the rates of obesity in America continue to rise, the need to address the epidemic is as important as ever. A 2015 survey from the Centers for Disease Control and Prevention (CDC) found that 36% of adults have obesity. Racial and ethnic minorities are disproportionately affected, especially the African American community—60% of African American women and 35% of men have obesity.

For all patients struggling with obesity, the road to proper treatment is filled with barriers. Through clinical care, advocacy and research, Stanford is looking to address these barriers and advance the field of obesity research and treatment.

The Need for Physician Education

When Stanford first came to Mass General as an Obesity Medicine Fellow in 2012, she took part in a project that evaluated disparities within the population of patients who have obesity – specifically what physicians are taught on the subject. Though she had intended to keep her focus narrow, Stanford realized that the problems extended beyond just racial and ethnic disparities.

“I found that physicians were so uneducated about obesity in general,” says Stanford. “That in itself became the disparity.”

Stanford says there is a lack of education, focus and attention to the treatment of obesity. Medical school students aren’t tested on the topic of obesity, yet every medical discipline will encounter patients that struggle with obesity. When physicians are taught about obesity, the message is oversimplified, Stanford says. “Right now we’re not being taught anything about obesity other than to just tell our patients to cut their calories and exercise more.”

But Stanford explains the factors contributing to an individual’s ability to manage his or her weight are far more complex than a generic calculation of calories in and calories out. Each body responds to its environment and even to the same foods very differently. Individual metabolism is constantly challenged by a variety of factors including genetics, life stressors and other internal and external dynamics.

Stanford believes that the path to better obesity treatment will come through a more multifaceted approach that addresses all these contributing factors. “If patients are still being told by their physicians that they just need to eat less and exercise more and that’s going to solve their excess weight at 300 pounds – whether they’re Caucasian or whether they’re African American or whether they’re Latino – everyone’s at a disadvantage,” says Stanford.

She thinks the lack of obesity education is due, in part, to the biased belief that the patient is to blame for their weight. “It’s unlike other disease processes, where you often can’t look at the person and determine their diagnosis,” explains Stanford. “When someone has obesity, it’s an outward show. And the judgments that happen just with this outward projection of their disease are enough to create barriers to their care.”

“You’re making these assumptions just based upon the way someone looks.”

Comprehensive Treatment

In her work as a clinician, researcher and educator, Stanford advocates for comprehensive obesity treatment that goes beyond behavioral therapy when necessary. She has seen great results in her patients who use any combination of behavioral, psychological, pharmaceutical or surgical interventions to treat their disease. Much of Stanford’s research has also focused on surgical and pharmacotherapeutic strategies to treat obesity.

Stanford strongly believes in trying all possible behavioral treatments before starting her patients on any medication or suggesting surgery. “Sometimes patients have dramatic improvement without me needing to introduce a drug and that’s great. If they need that drug, I’m all for it…but let me see that first.”

“It’s using all the tools in the tool bag,” says Stanford. “Some people need only one tool – maybe that’s removing sugar from their diet. But others need 20 tools. My goal is to find out which tools are necessary for each individual patient and treat accordingly.”